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Today, the Healthcare Industry is faced with:

  • Reducing wait time and increasing quality of care for patients
  • Changing budgets that cause resources to shift
  • New regulations that require processes to change
  • Limited time for training and process improvement

At, it’s our mission to simplify problem solving to help the Healthcare Industry overcome these obstacles so they can better serve their communities.

Through the use of Lean Six Sigma, King Khalid Military Hospital reduced the number of unnecessary X-Rays for head injury patients by 55%.

Saudi Arabia




Patient Care





The Problem

Unnecessary diagnostics delay a patient’s treatment while they wait for the results.  For head injuries presenting in the Emergency Room, any delay is critical. A skull x-ray will not show any bleeding in the brain or any abnormality in the brain tissue. This means the care for patients with a head injury can be delayed while they wait on a skull x-ray that provides little value.    

At King Khalid Military Hospital, the process was very simple, any patient with a head injury will automatically have a skull x-ray executed by the radiologist. The practice was not questioned until Dr. Nabeel Alansari, the Chair of the Emergency Department, and his improvement team decided to improve the process.  

Dr. Nabeel recalls “I have stopped the ordering of these x-rays in my practice since 1992.” Dr. Nabeel’s experience with evidence-based medicine made it clear how to streamline patient care and optimize outcomes. Evidence-based medicine is a systematic clinical problem-solving approach that integrates the best available research with clinical expertise and patient values. 

The challenge was how to successfully implement evidence-based medicine in this instance.

The Discovery

The improvement team conducted a Process Walk and inquired with the doctors about their practice. They were all in consensus that a skull x-ray is a must in all head injury patients. But when asked why an x-ray is a must, there was no clear answer.  It was the way they were taught 20 years ago!

The use of the analysis techniques such as the Fishbone Diagram and the 5 Whys technique generated a robust discussion among the physicians and radiologists. They knew what they practiced every day, and they were open to change. It became clear there was little awareness of the latest evidence-based medicine relating to these patients nor how to proceed with making the change.

The Solution

The team was able to implement effective Lean Six Sigma Problem-Solving training and process changes for the physicians and radiologists.  Dr. Nabeel stated, “Everyone bought into the idea that we needed to read, preach and practice what we preached.” Patient care procedures and the information system were updated to reflect the changes in ordering skull x-rays.

The Results

The improvements resulted in a 55% reduction in the ordering of skull x-rays.  Before the project, 71% of all patients received the x-ray and after improvement, this was reduced to 16%. Hospital administration is promoting the new practice throughout the 25-hospital system with the expectation of improving patient care and reducing operating costs.



Dr. Nabeel, understanding that resistance to change can be a difficult issue, engaged key stakeholders in leading the change. Also, it was important to maintain a “no-blame culture” and focus on the process rather than finger-pointing.  While reflecting on the importance of continuous improvement to patient care, Dr Nabeel commented, “I want to express my appreciation to Brigadier General Saleh Al Mohammedi and Brigadier Abdulla Al Thumali.  They have deeply affected me personally and work-wise, they were and are the torch guiding us in the right direction of quality care.”